Camp Pendleton’s Optimal Antepartum Visit Program

1. Camp Pendleton’s Optimal Antepartum Visit Program Cdr. Jack Klausen Cdr. John Holman

2. Antepartum Visits Goals • Education • Evaluation • Documentation • Intervention

3. Three types of Antepartum Visits • Normal • Falls with in accepted standards • Complicated • High Risk • Requires more time and effort • Teen Pregnancy • Singles Pregnancy • Educational

4. Optimization of Staff/Facilities • Fewer Visits at Strategic Times • Allows more Time for each visit • 20 vs 15 minutes (midwives) • 15 vs 10 minute (Physicians) • Each visit accomplishes a specific goal

5. Optimization of Patient’s Time • Fewer Unnecessary trips to hospital • Parking • Waiting Rooms • Missed Work • Baby Sitting • Why did I come to just get measured and weighed?

6. Why the Nine Visit Protocol • Recommended in 1989 by Expert Panel on the Content of Prenatal Care. • Studied extensively • Rigidly structured as to content and goals • Supported by educational material designed for Normal Obstetrical Patients • Allowed more time for other than normal pregnancies

7. Implementation • Nine Visit Pathway Created • Normal Pregnancy defined using Kaiser Colorado Region criteria • Began Process at Pregnancy Registration • Booklet Given to all patients • New Installment for next visit given at each visit

8. Visit Schedule • See Handout of Nine Visit Pathway • Method for removing from Nine Visit to Complicated Obstetrics Clinic

9. Educational • See Support Booklet • Soon Will Have in Spanish • See Web Page • Incorporated in our Classes

10. Modification of our Practice • All patients receive an anatomical U.S. at 18 Weeks

11. Historical Precedence at Camp Pendleton • All Pregnant Patients were seen on basically the same schedule • Averaged 15 Visits per Patient with no definable complication • No real structure as to when patient was seen in pregnancy only how far apart the visits were • No structures as to what was done and taught at each visit

12. Historical Precedence Cont’d • Comments on Form 600 were about random findings • Patients complained that they were not getting the information they needed • Complicated Obstetrics was not handled in a structured manner • Different approaches to care between Family Practice and Obstetrical Clinics

13. Under New System • Each Visit is Structured as to content and education • Patient knows ahead of time what to expect from the visit • Can Formulate Questions from handout from previous visit • Corpsman and Nurses can participate in Education Process

14. New System Continued • Allows better separation of Patients between MD and Nurse Providers • Allows Complicated Obstetrics to be seen in a formal context with cases discussed amongst providers • Soon will help integrate with our visiting MFM Staff • Assist resident Teaching

15. Advantage to date • We have adequate Obstetrical Appointments for both Complicated and Normal OB • Our Performance in the Navy Wide Patient satisfaction survey has improved. • The Provider Staff find the Normal Obstetrical Clinic Functions for more efficiently

16. Further Advantages • Patient Satisfaction is improved as evidenced by survey and postpartum questions • Unnecessary Ultrasounds have been markedly reduced • Patient has fewer opportunities to request them

17. Patient Care • We have been doing the 9 visit protocol for 7 months and there has been no evidence of any adverse effects • This was also the case in the Kaiser Studies • Rarely a patient will state that she was used to more visits with previous pregnancies • Explain reasoning to patient • Allow them extra visits

18. Plans • One Year Out to survey patients as their satisfaction • One Year Out to review our statistics for pregnancy complications to compare outcome • DEVELOP AN ANTEPARTUM DOCUMENTATION SHEET • Separate Normal and Complicated Patients